Presentation from Tuesday Community Meeting 29 May 2012

1. HOSPITAL ACQUIRED
INFECTION

2. "Not what you want to hear,
but what you need to know"

3. Nosocomial Infections
Hospital Acquired Infections
Infection in a hospitalized patient who was
admitted for a reason other than that infection
Not present or incubating on admission
 Occurring up to 30 days after discharge

4. Some Statistics for HAI:
•Affects approximately 10% of all in-patients
• Delays discharge
• Costs two times more than if there is no infection
• Direct cause of deaths

7. MRSA
Methicillin-Resistant
StaphylococcusAureus
Hosptial Acquired Infections
And
Community Acquired Infections

8. MRSA
How it is Spread

9. MRSA
What it Causes

10. KlebsiellaPneumoniae
Lastest Outbreak

11. KlebsiellaPneumoniae
Statistics

12. KlebsiellaPneumoniae
How it is Spread

13. KlebsiellaPneumo
niae
What it Causes

14. How to Avoid Infections
Do not go to the hospital
unless you
Are badly injured
or very ill

15. How to Avoid Infections
Do not go to the hospital
Unless someone
Who is dependent on You
For assistance
Is hospitalized

17. How to Avoid Infections
LIMIT VISITORS
OR
NO VISITORS

18. How to Avoid Infections
If you go to a hospital
For any reason,
Take a shower and
Change your clothes
When you get home

19. How to Avoid Infections
Insist on Handwashing
By Visitors
By Staff
By Physicians

21. Predisposing Factors
To Get an HAI
Age
Sex (Females after cardiac surgery)
Severity of Illness
Other medical conditions
Immunosuppressive Compromised
Malnutrition
Obesity

22. Other Factors
That Increase Risk of an HAI
More sick patients are admitted
More invasive procedures
New microorganisms
Increasing bacterial resistance to
antibiotics

23. The problem of HAI
USA
– Urinary tract infections: 2.4 per 100 admissions
– Pneumonia: 1 case per 100 admissions
– Surgical site infections: 2.8 per 100 operations
– One death every 6 minutes
Norway
– One of 19 patients admitted will develop a HAI

24. Cost of NCI
Extra days in hospital:
Urinary tract infections: 6
Pneumonia: 12
Surgical site infections: 7

25. HAI
30 % of HAI’s are Preventable!

26. Where do the
microbes
come from?

27. The Inanimate Environment
Can Facilitate Transmission
Xrepresents VRE culture positive sites
~ Contaminated surfaces increase cross-transmission~

28. Where Do The
Microbes Come From?
 patient's own flora
 cross infection from medical personnel
 cross infection from patient to patient
 hospital environment- inanimate objects
-

29. Spread of Infection
Airborne
Sneezing
 Coughing
 Air ventilation systems
 Air conditioners

30. Sometimes an illness is passed to others by a carrier, or a person who has been
infected by a germ but does not look or feel sick. This person may carry the germ
in their nose, throat, or stomach. They can pass the germ to others by coughing,
sneezing, or by not washing their hands properly.

31. Spread of Infection
Direct Contact
Hands
 Clothing
 Clinical Equipment

32. Spread of Infection
Indirect Contact
Bedpans, Urinals
 Remember the X’s on previous photo

33. HAI Urinary Tract Infections
Prevention
Limit length of time to have catheter
Drink plenty of water
When walking with catheter hold or
keep the bag mid-thigh or lower

34. HAI Post-Operative
Prevention
Cough
Deep Breathing Exercises
Get out of bed and WALK

35. HAI IV Catheter
Prevention
Immediately contact the nurse:
Redness
Burning
Pain
Hot to touch
Cold to touch
Swelling at the site

36. Many People Don’t Realize When
They Have Germs on Their Hands
• You can get 100s to 1000s of bacteria on your
hands by doing simple tasks like:
– Assisting patients up in bed
– Touching hands
– Touching any object in the room
– Touching the patient’s gown or bed sheets
– Do Not forget Door Knobs

37. Hand Washing is Important
Because…
• 80% of disease is spread by your hands.
• Hand washing is the most effective way to
prevent the spread of respiratory illness.
• Some germs can live on dry surfaces for
several hours and moist surfaces
like, sinks for 3 days.

38. Hand Hygiene
is the single most
effective intervention
to reduce the
cross transmission of
HAI infections

39. Visible soiling
Hands that are visibly soiled or
potentially grossly contaminated
with dirt or organic material
MUST by washed with liquid
soap and water

40. Alcohol Hand Rubs
• Require less time
• Can be strategically placed
• Readily accessible
• Multiple sites
• All patient care areas

41. Areas Most Frequently Missed
HAHS © 1999

42. Hand hygiene is the
simplest, most effective
measure for preventing
hospital-acquired
infections.

44. BE YOUR OWN ADVOCATE
When it comes to our health care, we patients
must be sure we understand exactly what the
risks and benefits are to any form of test or
treatment before we give consent.
Begin with, “Doctor, let me make sure I
understand….” Then restate what the doctor
just told you. If the doctor corrects you, then
restate it again until you know you have it right.

46. BE YOUR OWN ADVOCATE
You will need to be able to:
Listen and take notes
Research your condition
Ask intelligent questions
If you are not able to advocate for yourself,
don’t be too embarrassed to ask for help.

47. BE YOUR OWN ADVOCATE
Don't wait to be asked.
Most patients are too overcome to think about what
they need.
They may not know what they need, and they may
feel embarrassed.

48. BE YOUR OWN ADVOCATE
Ask questions politely:
Ask for staff to use another needle if they have
already poked you with it.
Ask staff to wash their hands before they help you.
Ask staff to wear gloves.

49. BE YOUR OWN ADVOCATE
Ask questions politely:
Ask for your room or bathroom to be cleaned. Be specific
if there is a problem.
Ask for a blanket to be placed on the wheelchair before
you sit in it.
Ask for a blanket to be placed in the chair in your room
before you sit on the chair.

50. BE YOUR OWN ADVOCATE
Get copies of all tests.
Before you leave, be sure ask the doctor for copies of
all tests. They won't offer them, so you need to ask.
Having them is tremendously helpful when visiting
other doctors.
In Panama, you are responsible to get all of your
laboratory, x-rays and other test results. They are not
automatically sent to your physician.

51. WHAT IS THE CONNECTION OF
ANTIBIOTIC USE TO HAI?
• High prevalence of resistant bacterial
strains present in the hospital
• High capacity of bacteria to mutate to
resistant strains
• Misuse and overuse of antibiotics

52. Viruses
• cause most common respiratory
illnesses, such as colds and coughs
• cause a variety of infections
• may take 2-3 weeks to resolve completely
• some viruses can be prevented by vaccines
and immunizations
• antibiotics do not work for viruses

53. Bacteria
• make you sick when they are where they
don’t belong or grow more rapidly than
normal
• live in your mouth, nose and throat
• are necessary for normal body functions like
digestion
• are one of the oldest living things on Earth

54. Antibiotic Resistant
Bacteria Are:
Bacteria that mutate and are able to
resist the antibiotics that are meant to
kill them.
This is a normal process speeded up by
the overuse and misuse of antibiotics.
8

55. Why is Antibiotic Misuse
a Problem?
1. Antibiotics become less effective and may not
work the next time you use them.
2. Improper use of antibiotics leads to more
antibiotic resistant bacteria.
3. Antibiotic resistant bacteria can be spread
throughout the community and from person to
person.
7

56. Support Appropriate
Antibiotic Use In Panama!
Everyone Can Help Keep Antibiotics Working
• By using antibiotics only when needed
• Following good hygiene practices

58. What to Expect When You Are Ready
To Be Discharged from the Hospital
Without all of the professional medical help
you have a better chance of recovery
You will be home with all of your familiar
germs

59. At Home Prevention Tips
for After Surgery:
Take a Good Multivitamin
 Drink lots of water
 Eat lots of protein if there is no
contraindication
 Fruits and Veggies are helpful to prevent
problems with constipation

60. At Home Prevention Tips
for After Surgery:
Get Plenty of Rest
 ASAP & with MDs ok – Get up and do
some walking around the house
 Limit your VISITORS

61. At Home Prevention Tips
for After Surgery:
Take your pain medication as prescribed by
your physician
 DO NOT try to be brave and hold back
from controlling your pain
 It takes more medicine to control pain if
you wait too long

63. Warning Signs of a
Possible Infection:
Fever
 Redness at the surgical site or injury
 Heat at the surgical site or inury

64. Warning Signs of a
Possible Infection:
Shortness of Breath
 Nausea and Vomiting
 Generalized weakness

65. What to Do if You Think
You Have and Infection:
Contact your physician

66. What to Do if You Think
You Have and Infection:
• Always take antibiotics exactly as prescribed
• Finish the whole prescription - do not stop when
you feel better
• Never save antibiotics for a future illness – or
share with others
• Do not take your friends pills or any old
antibiotics hanging around your home. They
may not work for that specific germ.
10

67. What to Do if You Think
You Have and Infection:
Take a marker and outline the borders of
the redness noted.
This will allow you to see if your antibiotic
is working.
10

69. Summary
Hospital Pathogen Unhappy Unhappy
patients director
Hospital Surveillance Happy Happy
Patients director

70. Questions?

71. THANK YOU &